News

Human Rights in Mental Health is active in many countries and working on many projects. Here we keep you informed of our work and what is important to us. If you wish to receive more information on any of the new-items, please write us at rvvoren@gip-global.org

Report on privatization of psychiatric services in Georgia published

More than twenty-five years after the collapse of the Soviet Union, much of the highly institutionalized and biologically oriented psychiatric service of the USSR is still in place, and resistance against the introduction of modern, community-based and user-oriented services remains very strong. Over the past decade Georgia has implemented a national mental health reform program that focused on the introduction of a humane and community based mental health system that meets basic standards of human rights. However, the full implementation of the program has not been realized. Of the newly developed services some were never fully operationalized and in other cases the process was halted or even reversed. Recently, privatization has been introduced in general health care as a format that would allow an influx of non-governmental capital, providing a new format that is targeted at upgrading services in mental health to an acceptable level.

Hitherto the state program to privatize health care facilities in the country did not include its mental health hospitals. The sudden and rather unexpected privatization process that started with the privatization of the hospitals in Qutiri and Batumi was not part of any of the national mental health plans that were adopted in recent years. For that reason, FGIP felt the urgent need to assess the situation, understand the basis and format of the privatization process and see where modifications ought to be implemented in order to ensure the continuation of care and protect the rights of persons with mental illness seeking professional help from national mental health care services.

Scope

In our assessment, we wanted to scrutinize in detail the opportunities and risks of privatization, understand the key drivers and considerations of the private investor’s business case, assess the issue of sustainability and what mechanisms would ensure good governance of the privatized institutions. We were also very keen to establish the plans of managers and the owner to improve the quality of care and to ensure that the rights of the patients are respected.

Conclusions

The outcome is not wholly positive. It is unclear what the goals are for privatization and how this will contribute to the implementation of the National Concept on Mental Health and National Strategy. The privatization process seems rushed and was carried out without any consultation with stakeholders. There was no open call and no predefined qualifications or experience required of potential investors, and no uniformity in the format of the two privatizations. There is no certainty in terms of the long-term planning of services and their financial sustainability. The investor’s business case remains unclear.

Recommendations

Privatization must come with clear expected standards on the quality of care, patient safety and aspects of human rights. A State monitoring body of qualified officials must make regular inspections, both announced and unannounced and there must be regular external monitoring, e.g. through a Societal council and/or a patient’s council. None of this currently exists and must be introduced as quickly as possible. Particular attention must be paid to forensic mental health and compulsory treatment units. A monopoly on care should be avoided at all cost. In the case of forensic psychiatric care this implies that at least one other facility should be opened.

Treatment and rehabilitation are not only matters of medication. Patients should be stimulated to participate in activities and need to prepared for a return into society. Much more attention should be directed towards the professional knowledge and skills of clinical personnel.

Absolute transparency is necessary, both with regard to the framework within which privatized mental health institutions function and with regard to ownership, business plans and profits. All future privatizations should follow a process whereby potential bidders must demonstrate that they meet specific criteria to qualify for the tendering outline their business models and long term plans to develop services. Contracts must ensure that they operate a service that meets a full range of financial and clinical standards. Privatization contracts must also stipulate the obligations from the Government. All hospitals, both State owned and private, should have these performance figures monitored and treated in non-discriminatory manner.

It is important to suspend the process of privatization until all the important preconditions and an adequate legal framework are in place. This should include a detailed list of requirements and specify sanctions that will follow in the case of non-compliance. Adequate governmental and non-governmental control mechanisms are essential, including the development of societal and patient councils and a mechanism for patients to submit complaints when they feel their rights have been violated.

Call for applications: 2017 Jim Birley Scholarship

Jim Birley Scholarship 2017

For young mental health professionals and other stakeholders who have shown exemplary commitment to issues of human rights in mental health

In November 2013, the Board of the Federation Global Initiative on Psychiatry decided to honor its late Past Chairman Dr. Jim Birley by instituting a scholarship focusing on issues that Dr. Birley was especially committed to: issues of human rights in mental health, and stimulating young mental health professionals and other stakeholders to pay special attention to the rights of persons with mental illness.

The Jim Birley Scholarship will be provided once a year during a high visibility event to a young mental health professional or another stakeholder (user, family-member or carer) who has shown exemplary commitment to the issue of human rights in mental health.

In 2017 one scholarships of 5,000 euro will be awarded (in case of equal points the scholarship might be divided between two winners). The scholarship is to be used for a cause to be proposed by the winner and should contribute to the strengthening of human rights in the field of mental health.

A committee consisting of four members, including a member of the Birley family, will select the winners from the submitted applications.

How to apply?

Candidates for the Jim Birley Scholarship should write to Human Rights in Mental Health-FGIP and in a letter explain:

Why they should be eligible,

Provide details about their background and what they have done to further human rights in mental health, and

Brazilian mental health threatened

On 10 December 2015, on the World Day of Human Rights and after a big meeting of workers in mental health field who are responsible for coordination of programs in municipalities, Marcelo Castro, the new Minister of Health in Brazil, has announced that Roberto Tykanori Kinoshita, the current Federal Coordinator of Mental Health and one of the main leaders of Brazilian mental health reform, would be substituted. Instead of him, the new Minister announced as the new federal coordinator is Valencius Wurch Duarte Filho, a psychiatrist who publically has affirmed to be against the principles of mentalhealth reforms and made opposition to the creation and implementation of the main law of mental health reform, approved in 2001. Also, he has been the director of one of the most horrible psychiatric hospitals of Brazil during the 1990’s, named Dr. Eiras and located in Rio de Janeiro. This psychiatric hospital, the biggest of Latin America during the 1990’s, was definitely closed in 2012, after a federal intervention due to several denounces of violation of human rights.

It is unacceptable the nomination of this psychiatrist to be the federal coordinator of mental health. Brazil is one of the countries with the most innovative and impressive reforms in mental health field in the world, recognized by WHO. The Brazilian mental health reform should continue.

It is not easy to explain how we get to this situation for who does not accompany politics in Brazil, especially the last year and a half, as it involves a big political and very serious scenario. But, for sure, it can be said that this situation is due to advance of a conservative politics. This is affecting not only health policies in general, but all the progressist politics on which we have made advances on the last 13 years.

Now, more than ever, we are facing the necessity to struggle towards the continuity of the psychiatric reform. This means that workers, users of services, families, civil society, and others have now to get together to think about what strategies we are going to develop to face this. And, for sure, this means to recover our historical banner to fight for a society without asylums. To stop this nomination, several meetings and protests are taking place in Brazil. But we have to join forces with other countries.

Defend the Brazilian mental health reform is to advocate for a society without asylums.

Winners of the 2015 Jim Birley Scholarships

It is with great pleasure that the Netherlands-based international foundation “Human Rights in Mental Health-FGIP” announces the first winners of the new Jim Birley Scholarships. The Scholarship is shared in 2015 between two outstanding advocates for human rights in mental health. The winners of the 2015 Jim Birley Scholarships are Anka Jgenti from Georgia and Charlene Sunkel from South Africa

Call for applications for the Jim Birley Scholarship

Jim Birley Scholarship 2015

In November 2013, the Board of the Federation Global Initiative on Psychiatry decided to honor its late Past Chairman Dr. Jim Birley by instituting a scholarship focusing on issues that Dr. Birley was especially committed to: issues of human rights in mental health, and stimulating young mental health professionals and other stakeholders to pay special attention to the rights of persons with mental illness.

The Jim Birley Scholarship will be provided once a year during a high visibility event to a young mental health professional or another stakeholder (user, family-member or carer) who has shown exemplary commitment to the issue of human rights in mental health.

In 2015 one scholarships of 5,000 euro will be awarded. The scholarship is to be used for a cause to be proposed by the winner and should contribute to the strengthening of human rights in the field of mental health.

A committee consisting of four members, including a member of the Birley family, will select the winners from the submitted applications.

How to apply?

Candidates for the Jim Birley Scholarship should write to Human Rights in Mental Health-FGIP and in a letter explain:

Why they should be eligible,

Provide details about their background and what they have done to further human rights in mental health, and

What they intend to do with the scholarship.

Two letters of recommendation should be added.The address: FGIP, P.O.Box 1956, 1200 BZ Hilversum, The Netherlands.

Applications should be submitted before March 15, 2015. The Selection Committee will then select the winners of that year.

World Mental Health Day Tbilisi

GIP celebrates the World Mental Health Day - 2014

Though lately the attitudes towards mental illness are slightly shifted to the right direction in Georgia, there is still a serious stigma attached to the mental health disorders and, specifically to schizophrenia.

Thus, this year we tried to reach out to young generation, but also to service users and their carers for raising awareness on self-stigma, among others.

The 10 October event “Life with Schizophrenia” organized by Foundation Global Initiative on Psychiatry (GIP) at National Library of Georgia intended to help the audience to realize that being diagnosed with schizophrenia can still mean that many can go on and have full and productive lives.

FGIP Chief Executive Dr. Robert van Voren spoke about stigma on mental disorders, silence surrounded the experiences and called to speak out and be open about schizophrenia, depression, etc.

Among the attendees were many young people asking stimulating questions, service users and their family members, MH professionals. The following discussion was moderated by Dr. Nino Makhashvili, GIP-Tbilisi director.

The paintings of Gela Jincharadze and Gio Kiladze - beneficiaries of art therapy workshop at Tbilisi Mental Health Center decorated the conference room during several days.

FGIP joins global movement to include mental health in MDG's

Human Right in Mental Health-FGIP calls all leaders to join global movement in most important mental health initiative addressing world’s biggest single cause of reduced lifespan

Human Right in Mental Health-FGIP announces today it joins to support the #FundaMentalSDG initiative to advocate adding clear, measurable mental health targets to the United Nations’ Post-2015 Sustainable Development Goals, which are about to be negotiated by the UN member states following the UN High-level Stocktaking Event on the Post-2015 Development Agenda in New York on 11 – 12 September 2014. The initiative takes up on the Preventing Suicide, A Global Imperative report, which was publicly released by the World Health Organization (WHO) last week at a mental health leaders and advocates gathering in Geneva, Switzerland, just a year after the WHO launched implementation discussions of the Global Mental Health Action Plan adopted by the United Nations 66th assembly.

According to the report by WHO, suicide is preventable, mental health disorders are treatable, and yet because we don’t significantly address it we lose over 800,000 lives annually, it is the second leading cause of death globally for youth ages 15-29, and is estimated to cost the United States alone over 100 billion dollars every year. Human Right in Mental Health-FGIP invites other organizations to support #FundaMentalSDG to join in the effort, asking the United Nations to include a specific mental health target and two indicators in this critical post-millennium agenda.

The July 19th 2014 United Nations draft of the Post-Millennium Goals includes an overall Health Goal: ‘Proposed goal 3. Ensure healthy lives and promote well-being for all at all ages’. A recent Editorial in the British Medical Journal (BMJ) by Professors Graham Thornicroft, Chairman of Human Rights in Mental Health-FGIP, and Vikram Patel the London School of Hygiene and Tropical Medicine, calls upon colleagues worldwide to include within this Health Goal the following specific mental illness target:

‘The provision of mental and physical health and social care services for people with mental disorders, in parity with resources for services addressing physical health.’

They also propose that this is directly supported by 2 indicators related to the WHO Mental Health Action Plan 2013-2020, adding that it is very difficult to achieve results without specific measurements:

(1) 'To ensure that service coverage for people with severe mental disorders in each country will have increased to at least 20% by 2020 (including a community orientated package of interventions for people with psychosis; bipolar affective disorder; or moderate-severe depression).'

(2) ‘To increase the amount invested in mental health (as a % of total health budget) by 100% by 2020 in each low and middle income country’

According to Thornicroft and Patel’s article in the BMJ, there is compelling evidence to show that improved global mental health is a necessity for overall human and societal development. For example, “poorer mental health is a precursor to reduced resilience to conflict,” and not only that, “it is also a barrier to achieving the suggested goal for promoting peaceful and inclusive societies for sustainable development, providing access to justice for all, building effective, accountable and inclusive institutions at all levels.”

Ukrainian psychiatrists appeal for help to prevent political abuse of psychiatry

September 3, 2014

Appeal to the world psychiatric community

The history with the Ukrainian air force officer Nadezhda Savchenko has acquired a psychiatric aspect. Detained by Russian secret services on the territory of Ukraine, she was illegally transferred to Russia and by a decision of a Russian court sent to the Serbski Institute (currently the Federal State-budget Institution «State Scientific Center for Social and Forensic Psychiatry named after Serbski» of the Ministry of Health of the Russian Federation) to undergo a forensic psychiatric evaluation.

As a air force pilot on duty and a officer of the Ukrainian army, she regularly underwent medical check-ups, among them psychiatric ones. The mental health of Ms. Savchenko was before never subject to any doubt. This is confirmed both by relatives and fellow officers. On basis of this we can assume that the motive to send the Ukrainian officer Nadezhda Savchenko for psychiatric examination is her courageous behavior in a Russian court.

We, Ukrainian psychiatrists, remember the recent history of declaring healthy people mentally ill behind the walls of the Serbski Institute in Moscow. We also know about new cases of political abuse of psychiatry in the Russia of today. The authoritarian political regime in Russia is able to use the «psychiatric cover up» also in the case of Nadezhda Savchenko.

We urgently ask you to pay attention to this case. And to put pressure, both personally and within the framework of the work of national psychiatric associations, on the Russian authorities, who continue the practice of psychiatric repression in their country.

We, psychiatrists, have the obligation to terminate this practice. Otherwise, to the list of victims of abuse of psychiatry for political purposes who were “determined” mentally ill in the Serbski Institute in the USSR (Natalya Gorbanevskaya, Valeriya Novodvorskaya, Anna Mikhailenko, Vladimir Bukovsky, Pyotr Grigorenko, Leonid Plyushch and hundreds of other dissidents) the name of Nadezhda Savchenko can be added.

DSM and ICD – two psychiatric classifications on the block - Peter Tyrer

What are these acronyms and are they of value to psychiatry? The answers to the first question are simple. DSM stands for Diagnostic and Statistical Manual for Mental Disorders, and its 5th revision was published in May 2013, and ICD is short for the International Classification of Diseases, the 11th revision which is due to be published in 2015 or 2016. The value question is a matter of debate. Only the complete anti-psychiatry zealots believes neither classification is of value, but the amount of confidence we have in both of them varies from almost religious belief to extreme scepticism.

Where do I stand? In the middle, wobbling on top of a rickety fence. I have rechristened the acronym, DSM as both Diagnosis for Simple Minds, and Diagnosis as a Source of Money (Tyrer, 2012), as both are true. The ‘operational criteria’ are listed for each disorder and can be ticked off simply, and the American Psychiatric Association relies on the income from DSM for much of its core work. But I am being slightly unfair; DSM is a noble but flawed attempt to give order to a very disordered subject. Psychiatric classification involves much more guesswork than medical classification and filling the gaps is a task that all can criticise successfully with all getting prizes. DSM-5 has come in for heavier criticism than other revisions, as it planned originally on making the classification a true beacon of science – a ‘paradigm shift ‘ in which biological measures would be used to describe the new disorders. But it never got to first base. Instead we have a reshuffle of disorders, and new ones that tend to increase pathology in the population. These include premenstrual dysphoric disorder, disruptive mood dysregulation disorder, illness anxiety, hoarding, binge eating and minor neurocognitive disorder. Allen Frances, the chair of DSM-IV, berates the new DSM masters as being out of control and has led the campaign to save the world from being diagnosed with a DSM disorder (Frances, 2013).

ICD is in somewhat better odour, not least as it is the official classification of disease across the world. But the revision of the classification is badly resourced and it is difficult for it not to follow the much better funded studies that back up DSM. But it is fighting back, and when I spoke in Vilnius in April at a meeting of the Lithuanian Psychiatric Association (Lietuvos psychiatry asociacija) there was much more enthusiasm for a reinvigorated classification that was not linked to any one country and which could be embraced by practitioners across the world. And there are benefits from a world-wide approach. Russia uses ICD and at a meeting of the Serbian Psychiatric Association two years ago Valery Krasnov of the Moscow Research Institute of Psychiatry presented data on the epidemiology of ‘sluggish schizophrenia’. Although this was never an ICD diagnosis it was widely used to imprison dissidents in psychiatric institutions, and Valery’s statistics showed that this strange disorder had almost completely disappeared from national figures since its heyday 40 years ago – mainly being replaced by personality and mood disorders. One of the essential tasks of a good psychiatric diagnostic system is to be embraced sufficiently to be independent of political pressures of all sorts and we hope that ICD-11 when it appears will be a much cleaner and well-organised diagnostic system than it has been in the past.

The organisations Maudsley International and Human Rights in Mental Health-FGIP (formerly the Federation Global Initiative on Psychiatry) have decided to engage in a strategic alliance in order to respond more effectively to requests for assistance from the global mental health community. The alliance combines the internationally acclaimed expertise of Maudsley International (and their partners in the Institute of Psychiatry, King’s College London and South London & Maudsley NHS Foundation Trust) with the decades of experience in supporting the development of community-based and user-oriented mental health care services in developing countries around the world of FGIP. Apart from collaborating closely in projects and thus increasing both the quality and cost-effectiveness of our output, the alliance plans to hold regular meetings and conferences on the issue of mental health care development in developing countries. More information will be posted within the near future.

Maidan Medical Fund for trauma care in Ukraine

Trauma and bereavement care in Ukraine

Over the past three months, the world has witnessed momentous events in Ukraine. What started as a protest by students in favor of an associate agreement with the European Union, turned into a people’s uprising against an autocratic and corrupt regime. After three months of mass demonstrations at the Maidan in Kyiv, and later in cities all across Ukraine, the old rulers fled the country. What happened before our eyes is not as much a choice between “East” or “West” but a revolution led by the first post-Soviet generation.

"Piece of Progress"

"Piece of Progress" prize is awarded to Nino Makhashvili, GIP-Tbilisi Director, for the contribution to the field of Georgian penitentiary healthcare

On December 3, 2013 the Ministry of Corrections and Legal Assistance with a joint initiative of the European Union and the Council of Europe held a mid-term conference entitled " Prison Health Care Reform in Georgia – we are keeping our promise".